General Medical Services Scheme - Budget

1 Staff Paper 2016 General Medical Services Scheme July, 2016 Jenny Connors Health Vote Department of Public Expenditure and Reform This paper has been prepared by IGEES staff in the Department of Public Expenditure and Reform. The views presented in this paper are those of the authors alone and do not represent the official views of the Department of Public Expenditure and Reform or the Minister for Public Expenditure and Reform. The paper was prepared in the context of an on-going Budget negotiation process and reflects the data available to the authors at a given point in time.

2 2 July, 2016 Summary The General Medical Services (GMS) Scheme provides access to Medical and surgical Services for persons for whom acquiring such Services would present undue hardship. Under the GMS Scheme , persons are entitled to a Medical Card (MC) or a GP Visit Card (GPVC). In 2014, 43% of the population were covered under the GMS Scheme ; 40% Medical cardholders and 3% GP visit cardholders. Key characteristics of Medical and GP Visit cardholders are set out in the table below. Profile of GMS Users Medical cardholders.

3 Age - largest share of cards held by children and the elderly Gender - females hold 53% of cards, a greater proportion than their 51% share of population Marital status - high proportion of cardholders are widowed or divorced Regional location cardholders are more concentrated in rural areas Income status cardholders are more concentrated in lower income deciles Health status cardholders report poorer health status than those without a card GP Visit cardholders: Age children and elderly persons hold the greatest proportion of cards Gender similar to Medical card holders, females hold a higher percentage of cards compared with female population share Marital status - high proportion of cardholders are single or married Regional location rural areas hold the greater share of cardholders Income status mid - income deciles have the highest concentration of cardholders.

4 Primarily the fifth income decile Health status cardholder describe a poorer health status than those without a card Medical and GP visit card numbers increased sharply between 2008 and 2012 reflecting the onset of the economic downturn. Numbers reached a peak in 2013 and thereafter began to fall. This falloff in cards derived from those aged 25-34 years, students, and employed persons. 3 Introduction This paper forms part of the Social Impact Assessment (SIA) Series which aims to apply an evidence based methodology to assess the impact of policy on households financial position.

5 The focus is primarily on the impact of the provision of public Services . There are a number of challenges in undertaking should an analysis given the difficulties associated with quantifying the value of public Services to an individual. The Programme for Government1 commits to develop the process of Budget and policy proofing as a means of advancing equality , reducing poverty and strengthening economic and social rights. The Social Impact Assessment (SIA) Framework2 is a first step in this process. In order to enable the analysis of future budgetary policy decisions and answer questions regarding who may benefit or lose from these decisions, a baseline exercise is required to identify the current position with regard to expenditure and recipients of chosen policies.

6 This analysis can then be used as a reference point in the future. In particular, this paper is a point-in-time exercise to provide a baseline distributional assessment of the impact of General Medical Services Scheme . It will identify the level of spend in this area and generate a profile of Scheme beneficiaries. The profile will distinguish recipients based on a number of characteristics including age, gender, region, etc. depending on the data available at the time of the analysis. Some studies have been carried out in the area by the Economic and Social Research Institute (ESRI).

7 The ESRI examined how means testing for GMS can be modelled using detailed income and demographic information from the Survey on Income and Living Conditions. The approach taken applies the criteria for means-tested cards to each family in the nationally representative sample by using the information they provide on income and family composition. The findings of the income related analysis in this paper correspond with the findings in the ESRI paper. This paper supplements previous analysis by providing an examination of additional characteristics of GMS users through both objective and subjective measures.

8 The objectives of the paper are in line with the overall SIA framework and analysis in other policy areas: Provide an overview of GMS in terms of eligibility criteria Summarise trends in card numbers and expenditure over the last number of years Set out the key characteristics of recipients of Medical cards and GP visit cards Identify significant changes in characteristics since card numbers peaked in 2013 1 Published May 2016 2 Social Impact Assessment Framework, Lawless J.

9 And Reilly D. 2016 4 Section 1 of the paper provides a brief summary of the GMS Scheme in terms of eligibility and historic trends in spend and volume. Section 2 outlines the two key data sources used in the study. Section 3 focuses on the proportion of card holders across a number of key characteristics. The characteristics span from age, gender, economic status to reported income in order to provide a profile of card holders in 2014 essentially providing a baseline position for the GMS Scheme . Lastly, Medical cards reached a peak in numbers in 2013 and thereafter began to fall.

10 Section 4 examines key changes in characteristics from 2013 to 2014 in order to identify the cohorts that had the largest decrease in the number of Medical cards. This is a prime example of analysis as part of the SIA series and will be the kind of analysis conducted going forward. 5 Section 1: Overview of Scheme The GMS Scheme provides Medical and GP visit cards based on a means test. Medical cardholders receive free access to GP Services and pharmaceuticals while GP visit cardholders receive free access to GP Services only.